SF424 App (agmt) F18AC00087.pdf

Application for Federal Assistance SF-424

* 1. Type of Submission:

I I Preapplication

IXI Application

I IChanged/Corrected Application

3. Date Received:

01/10/2018

5a. Federal Entity Identifier:

State Use Only:

* 2. Type of Application:

lEl New I IContinuation

I IRevision

4. Applicant Identifier:

if Revision, select appropriate letter(s):

Other (Specify):

5b. Federal Award Identifier:

6. Date Received by State: 7. State Application Identifier:

8. APPLICANT INFORMATION:

* a. Legal Name: Earzh Discovery Institute

b. Employer/Taxpayer Identification Number (EIN/TIN): * c. Organizational DUNS:

:62288903 0194280190000

d. Address:

120 North Park Drive

El Cajon

0MB Number: 4040-0004

Expiration Date: 10/31/2019

* Street1:

Street2:

* City:

County/Parish:

* State;

Province:

* Country:

CA: California

USA: UNITED STATES

Zip / Postal Code: 92021-4 24 6

e. Organizational Unit:

Department Name: Division Name:

f. Name and contact information of person to be contacted on matters invoiving this appiication:

Prefix:

Middle Name:

* Last Name:

Suffix:

Ms.

Chadwick

MPH

Title: Executive Director

Organizational Affiliation:

Telephone Numt>er: 619-654-3793

Email: info@eart'ndiscovery. erg

* First Name: Cathleen

Fax Number:

* 9. Type of Applicant 1: Select Applicant Type:

M: MDnprori". with tL'iCi IRS Status (Other than Institution of Higher Education)

Type of Applicant 2; Select Applicant Type;

Type of Applicant 3: Select Applicant Type:

* Other (specify):

10. Name of Federal Agency:

11. Catalog of Federal Domestic Assistance Number;

CFDA Title:

You th Engagemer." , educat or, a:-.:: e:r:r ; yr,e:.-

12. Funding Opportunity Number:

Title

13. Competition IdentiHcation Number:

Title:

14. Areas Affected by Project (Cities, Counties, States, etc.):

Add Attachment

* 15. Descriptive Title of Applicant's Project:

Urban Refuge Er.gagenien: Tr.rougr. Conservation Stewardship and Environmental Education

Attach supporting documents as specified in agency instructions, Add Attachments

16. Congressional Districts Of:

• a. Applicant ^,o ' b Program/Project 50, 51

Attach an additional list of Program/Project Congressional Districts if needed

Add Attachment j 1 -oi-itr.nient | | View .Att&chmeni j

17. Proposed Project:

" a. Start Date ii'i/iii .yii- "b End Date. 09''30/2018

18. Estimated Funding (S):

' a. Federal

' b. Applicant

* c. State

* d. Local

* e. OBier

*f. Program income

* g. TOTAL

8 0, 4 i '.i . 1.10

* 19. Is Application Subject to Review By State Under Executive Order 12372 Process?

a. This application was made available to the State under the Executive Order 12372 Process for review on

b. Program is subject to E G 12372 but has not been selected by the State for review

X c. Program IS not covered by E.O 12372

* 20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes." provide explanation in attachment.)

Yes X

If "Yes", provide explanation and attach

Add Attachme- -Ot-i

21. *By signing this application. I certify (1) to the statements contained in the list of certifications** and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U.S. Code. Title 218. Section 1001)

X "iAGREE

** The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific instructions.

Authorized Representative:

Prefix: Ms.

Middle Name: £

"LastName Chadwick

Suffix HpH

Title: Executive En rector

Telephone Number; 61 ?- b 54 - 37 9 3

Email' intoi?eatthdiscovery. ora

Signature of Authorized Representative

* First Name: '7.athle'=fn

Fax Number

•Date Signed 01/10/2013

AA. A

Areas Affected:

Environmental education: El Cajon, La Mesa, Spring Valley, Lakeside, Imperial Beach, Campo.

Conservation Stewardship: El Cajon, La Mesa, Spring Valley, Jamul, Rancho San Diego, Chula Vista, Bonita, Eastlake.